Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life

BACKGROUND: Depressive symptoms are common among patients with chronic obstructive pulmonary disease (COPD), but depression's impact on COPD outcomes has not been fully investigated. We evaluated the impact of comorbid depression on mortality, hospital readmission, smoking behavior, respiratory symptom burden, and physical and social functioning in patients with COPD. METHODS: In this prospective cohort study, 376 consecutive patients with COPD hospitalized for acute exacerbation were followed up for 1 year. The independent associations of baseline comorbid depression (designated as a Hospital Anxiety and Depression Scale score of > or =8) with mortality, hospital readmission, length of stay, persistent smoking, and quality of life (determined by responses to the St George Respiratory Questionnaire) were evaluated after adjusting for potential confounders. RESULTS: The prevalence of depression at admission was 44.4%. The median follow-up duration was 369 days, during which 57 patients (15.2%) died, and 202 (53.7%) were readmitted at least once. Multivariate analyses showed that depression was significantly associated with mortality (hazard ratio, 1.93; 95% confidence interval, 1.04-3.58), longer index stay (mean, 1.1 more days; P = .02) and total stay (mean, 3.0 more days; P = .047), persistent smoking at 6 months (odds ratio, 2.30; 95% confidence interval, 1.17-4.52), and 12% to 37% worse symptoms, activities, and impact subscale scores and total score on the St George Respiratory Questionnaire at the index hospitalization and 1 year later, even after controlling for chronicity and severity of COPD, comorbidities, and behavioral, psychosocial, and socioeconomic variables. CONCLUSIONS: Comorbid depressive symptoms in patients with COPD are associated with poorer survival, longer hospitalization stay, persistent smoking, increased symptom burden, and poorer physical and social functioning. Interventions that reduce depressive symptoms may potentially affect COPD outcomes.     

Subsyndromal depression in old age: clinical significance and impact in a multi-ethnic community sample of elderly Singaporeans

OBJECTIVE: This cross-sectional study examined the clinical significance and impact of subsyndromal depression in a sample of elderly people living in the community in Singapore. METHOD: Data were analyzed from a population survey (the Singapore National Mental Health Survey of the Elderly). A total of 1092 respondents from a nationally representative multi-ethnic (Chinese, Malay and Indian) stratified random sample of older adults aged 60 and above were examined for depression using the Geriatric Mental State Examination (GMS). Diagnostic confidence levels of 3-5 indicated a DSM-IV diagnosis of syndromal depression, and 1-2 indicated subsyndromal depression. Other variables included sociodemographic characteristics, psychiatric and medical comorbidities, MMSE, health awareness, health and functional status. RESULTS: Subjects with subsyndromal depression were more likely to have poor socioeconomic status, cognitive impairment, anxiety, and measures of poor mental, physical and functional status compared with non-depressed subjects, and were similar to or worse than syndromal cases. In multivariate analyses that controlled for age, gender, ethnicity, education and several other sociodemographic factors, both subsyndromal and syndromal depression were significantly associated with higher numbers of medical comorbidities, diagnoses of comorbid dementia and anxiety, lower MMSE scores, self-reported mental health problem, functional disability and poor health status. CONCLUSION: In this Asian population, subsydromal depression had the same clinical significance and health impact as syndromal depression, similar to findings in the West.     

A Cephalometric Study on the Relationship Between the Occlusal Plane, Ala-Tragus and Camper’s Lines in Subjects with Angle’s Class I, Class II and Class III Occlusion

Considering the importance of the occlusal plane orientation in complete denture prostheses, a study was conducted on the relationship between this plane with ala-tragus and Camper’s lines in soft tissue among individuals with class I, class II and class III occlusion. The aim of the present study was to define the best soft tissue index by which the location and inclination of the occlusal plane in complete dentures could be established. A total of 60 subjects were selected for the study. Lateral cephalograms of these subjects were obtained. Tracings and analysis was done to confirm to the skeletal relationship of subjects to be class I (normal), class II (prognathic maxilla) and class III (retrognathic maxilla). 20 Subjects of each group were screened for further analysis. Radiopaque markers were attached to the intended points on soft tissue and then standard lateral cephalograms were obtained from each subject. The angles between the following lines were measured: Occlusal line, Camper’s line (ala-porion), AT1 (ala-superior border of tragus), AT2 (ala-mid-tragus) and AT3 (ala-inferior border of tragus). The mean values and standard deviations were calculated for all the groups. The mean values calculated were subjected to repeated ANOVA test and significance was evaluated. Comparison of the results by the ANOVA test exhibited a significant difference. In class I subjects, it was evaluated that in 75 % individuals, the posterior reference point was found to be the mid-tragus; of class II subjects, in 60 % individuals, the posterior reference point was found to be the mid-tragus; and of class III subjects, in 75 % individuals, the posterior reference point was found to be the inferior border of tragus.     

Enough is enough: Radiation doses in children with gastrojejunal tubes

IntroductionMany children with gastric feeding intolerance require postpyloric tube feeding via a gastrojejunal (GJ) tube. Placement or positioning of these tubes is typically a procedure with a low dose of radiation. Although the risk of developing cancer from radiation exposure owing to computed tomography scans is well-documented in children, the risk of cumulative radiation exposure owing to frequent GJ tube replacement often goes unnoticed in the clinical decision-making process. We sought to define the frequency and cost of GJ tube replacement, quantify the radiation doses associated with the initial placement and replacements, and assess the number of conversions to surgical jejunostomies.MethodsAll pediatric patients who underwent GJ tube placement or replacement by Interventional Radiology (IR), surgery, and gastroenterology between 2010 and 2018 at a single center were reviewed. We evaluated the total cost of the initial placement and replacement of each GJ tube, the total number of replacements, and the cumulative radiation dose (mGy).ResultsWe identified 203 patients who underwent GJ tube placement and/or replacement, of which 150 had radiation data available. Patients underwent a median of five GJ tube replacement procedures, and there was a wide range in the number of replacements per patient, from zero to 88. Patients were exposed to a median cumulative dose of 6.0 mGy (IQR: 2.2, 22.6). Nine percent of patients with available radiation data were exposed to more than 50 mGy, solely from GJ tube replacements. The median cost per replacement was $1170. The sum of the cost of the replacements for dislodged GJs translated to more than $1.4 million during the study period.ConclusionsOverall, the average dose per GJ replacement was 3.50 mGy among all patients with available data. Nine percent of patients (14/150) were exposed to greater than 50 mGy cumulative radiation solely from GJ replacements. Patients who receive more than 50 mGy of cumulative radiation dose, who undergo seven GJ tube replacements in one year, or two consecutive GJ tube replacement procedures with radiation doses exceeding 10 mGy (per replacement) should be considered for a surgical jejunostomy.Level of evidenceIVType of studyTreatment study.     

Pregnancy in a Rare Case of Intracranial Rosai Dorfman Disease (RDD)

The Journal of Obstetrics and Gynecology of India -     

Mask Acne in Skin of Color: A Significant Dermatological Condition Amidst the COVID-19 Pandemic

The COVID-19 pandemic has given rise to the need to use personal protective equipment such as masks, among healthcare professionals and the general public. Numerous facial dermatoses linked to the use of masks have been described, from which the term maskne or mask acne has emerged. Although prolonged mask usage has been necessary, and a vast majority of people develop various skin conditions, there is a lack of research on the effects of masks on skin. In this article, we review alterations in biochemical properties of skin associated with mask use in individuals with skin of color and the factors predisposing them to developing acne. Because masks are crucial in preventing the spread of COVID-19, we also elucidate some fundamental strategies such as gentle skin care measures, decreasing the duration of mask wear, and following appropriate protocols for mask re-use, which may prevent mask acne and its long-term effects.     

Ethnic and educational differences in cognitive test performance on mini-mental state examination in Asians.

OBJECTIVE: The objective of this study is to examine ethnic differences in Mini-Mental State Examination (MMSE) test performance in discriminating between demented and nondemented elderly Asians. METHODS: A nationally representative population sample (N = 1,092) of community-living elderly, comprising Chinese, Malays, and Indians in Singapore, was interviewed using MMSE, Geriatric Mental State, and demographic and health questionnaires. RESULTS: There were significant ethnic differences in mean MMSE scores among Chinese (26.2), Indians (25.0), and Malays (23.6), but only in noneducated subjects. No ethnic differences in MMSE were observed in higher educated subjects. The sample proportion of subjects with dementia was 4.2% in Chinese, 9.4% in Malays, and 8.8% in Indians. Overall, MMSE discriminated well between subjects with and without dementia (cutoff: 23/24, area under the curve: 95%, sensitivity: 97.5%, specificity: 75.6%). MMSE test performance was much better in higher educated subjects (higher specificity: 85.2%). Lower specificities were shown in less educated subjects (57.3%), and in Malays (62.8%), and especially in less educated Malays (35.3%) and Indians (50.0%). Significant differences in MMSE scores in less educated subjects persisted after adjusting for differences in sociodemographic, health, and behavioral variables CONCLUSION: Ethnic nonequivalence in MMSE test performance should be taken into account in dementia screening in Asians in less educated subjects. Known correlates of cognitive functioning did not sufficiently explain these differences.